What Is Non-Hodgkin's Lymphoma?

Dance Moms alum Abby Lee Miller has received a preliminary cancer diagnosis after what doctors initially believed to be a spinal infection turned out to be non-Hodgkin's lymphoma.

The dance instructor underwent emergency spinal surgery early Tuesday morning at Cedar Sinai Marina Del Ray Hospital in California, after she presented with persistent pain and weakness in her arm. Her doctor, Hooman M. Melamed, M.D., told People that "her condition rapidly deteriorated."

Now, Abby will be meeting with an oncologist to devise a treatment plan that will likely include chemotherapy and radiation, Melamed told People.

What is non-Hodgkin's lymphoma?

Lymphomas are cancers of the immune system, explains Otis Brawley, M.D., chief medical and scientific officer at the American Cancer Society. "The lymphatic system is a system that transports waste products throughout the body; it parallels the arteries and veins," Brawley tells Women's Health. "It has filters along the way which are called lymph nodes. Lymphoma is a cancer of the lymph nodes."

There are two subsets of lymphoma: Hodgkin's lymphoma and non-Hodgkin's lymphoma (also called NHL).

"People will wake up in the middle of the night and the bed is just drenched with sweat."

Hodgkin's lymphoma is characterized by the presence of large, atypical cells called Reed-Sternberg cells in the lymph nodes. "A Reed-Sternberg cell looks like a penny placed on a plate: It’s a small, circular disk inside of a larger disk," Brawley says. If a biopsy reveals these cells, the patient has Hodgkin's lymphoma; if not, it's non-Hodgkin's lymphoma, of which there are "well over two dozen different types," according to Brawley.

Non-Hodgkin's lymphoma is unchecked cell growth in the lymph nodes, which can spread to other areas of the body or remain localized, Brawley says.

Symptoms of non-Hodgkin's lymphoma

The primary symptoms of non-Hodgkin's lymphoma, according to Brawley, are weight loss, loss of appetite, fever, itching, and intense night sweats: "People will wake up in the middle of the night and the bed is just drenched with sweat," Brawley explained. "You commonly hear someone say, 'I woke up in the middle of the night and I was so wet, I thought I had urinated on myself.'" In rare cases, a rash might crop up, too.

When a patient comes in with these symptoms, they might also be able to feel the lymph nodes on their necks, in their armpits, or in their groins. If the nodes are "suspicious," Brawley says, pathologists will do a biopsy to determine whether or not they're dealing with lymphoma, and if so, what kind of lymphoma it is.

In Abby's case, while Brawley notes that he cannot diagnose a patient whom he has never met and who is not sitting in front of him, he says, "We do see people who have lymphomas that start in their bodies, usually in their chests, but they can start elsewhere—chest, neck, and so forth—and many of these lymphomas will actually spread to someone’s brain."

Neurolymphomas, he continued, present in the brain or spinal cord. That's not so unusual, he explained: If you're an oncologist who has been practicing for two or three decades and you don't personally encounter a case like this, you'll likely work with someone who has.

How to treat non-Hodgkin's lymphoma

Some lymphomas—nodular lymphomas—grow slowly, and may not merit treatment. Some grow at an intermediate rate that allows doctors time to make a meticulous treatment plan. Some aggressive forms grow visibly within hours, and require immediate, emergency treatment.

"The treatment course for most lymphomas involves either chemotherapy and radiation or chemotherapy alone," Brawley says. "If someone has lymphoma that is localized to one particular area, say the brain and spinal cord or the left upper side of the neck, we will treat them both with chemotherapy and radiation. If the disease is quite diffuse, we can’t radiate large parts of people’s bodies, so those are the folks who only get chemotherapy."

Stage 1 and 2 non-Hodgkin's lymphomas are still "relatively confined," he adds, so those patients will often get chemo and radiation.

Stage 3 and 4 will have spread too far for radiation. In cases where the lymphoma does not respond to cancer drugs, doctors might be able to do an autologous bone marrow transplant, wherein doctors harvest the patient's bone marrow and transfer it to a freezer while they flood the patient's body with doses of chemotherapy high enough to kill off the cancer in the immune system.

Once the patient passes those chemicals, doctors transfer the bone marrow back. For some hard-to-treat lymphomas, Brawley notes, this procedure can lead to decades-long remission.

Is non-Hodgkin's lymphoma fatal?

Brawley says that non-Hodgkin's lymphoma accounts for 5 percent of all cancer diagnoses in men and 4 percent of all cancer diagnoses in women. It's the seventh most common form of cancer for both genders and the ninth most common cause of cancer fatalities, constituting 4 percent of cancer deaths in men and 3 percent of cancer deaths in women.

Whether or not NHL will be fatal "depends on the kind of lymphoma you have," Brawley adds. "We only treat the nodular lymphomas that are bothering people," and many diffuse lymphomas can also be treated successfully, putting patients in complete remission, he says.

The five-year survival rate for people with non-Hodgkin's lymphoma is 70 percent, the American Cancer Society reports.

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